In matters of style, swim with the current; in matters of principle, stand firm like a rock. Thomas Jefferson

The Corporate Practice of Medicine

One hears repeatedly that managed care penetration in health care delivery continues unabated; that it continues to interpose itself in the medical decision-making process erstwhile reserved to the patient and his physician; and that it continues "to dramatically increase its economic shares in the medical marketplace despite intense physician dissatisfaction." How has all of this taken place? What has allowed this egregious corporate penetration to take place in an ancient, beneficent, and revered profession that had held itself together as a sacred calling for centuries? I believe that the answers to these questions are found in the fact that the recent leaders of the profession (with notable exceptions) have allowed relentless government intrusion and third-party intervention within the practice and even ethics of medicine and have relented the patient-doctor relationship to be torn asunder.

And how was this accomplished? By the accommodating policies of successive pragmatic "leaders" and medical politicians allowing and presiding over the step-by-step transmogrification of the absolute Hippocratic principles that have served the profession so well for 2500 years.

Yes, successive pragmatic leaderships fell for the perverse concept that ethics are flexible and must change to accommodate the times. While few have said so explicitly, their consensual actions and sometimes, in moments of candid lucidity, their rhetoric have essentially rejected the fact that while men's attitudes and fashions change with the times, principles of ethics remain absolute. Or as Dr. Jane M. Orient has pointed out, "The books may need to be revised not because truth evolves, but because men make errors."

It is nothing short of astonishing the way medical politicians in organized medicine claiming to represent all physicians, have allowed, in less than half a century, the step-by-step transmutation of our medical ethics for the sake of compromise and political expediency. Today, medical ethics are ever-changing, flexible guidelines that conveniently change rules to fit the time. For example, these flexible ethics have validated the corporate practice of medicine and managed care, concepts centered not in the benefit of the sick, individual patient, but for the benefit of the managed care networks, whether run by doctors or not, with the explicit intention of attaining profits at the expense of patient care. We now know, for instance, the new physician executives earn an average of 12 percent more than their non-physician colleagues as recently reported in AMNews.(1)

Another beneficiary of managed care is the government which is able to use the concept to propound the illusion of achieving such noble-sounding goals as universal coverage and affordable health care via the "free market," while scoring political points. The result of such noble-sounding goals and political largesses are nefarious and insidious rationing, price controls, and wealth redistribution via the much hackneyed, incremental "health care reforms." These piecemeal changes in medical care are sold to the public as portability and renewability of insurance (which is touted as "coverage that can not be taken away") like in the Kassebaum-Kennedy law and progressively moving toward universal coverage for children as in KidCare. If what happened in Minnesota is any guide, from kids they will move to universal health care to encompass the entire middle class which would then drop their private insurance to obtain subsidized, pre-paid, government insurance via managed care. Gradually, the entire middle class is given corporate socialized medicine as an entitlement and turned inauspiciously into a government-dependent class.

The reality is that with managed care we have the seemingly paradoxical purposes of saving money for the government while making profits for the managed care corporations --- indeed, a mutually beneficial transaction for the powerful parties involved. But, the doctors, the ones giving the care, are used by both, while the patients, sick and vulnerable, are left out of the equation.

This perversion of medical ethics has served the purpose of managed care well because the physician is de facto answerable only to the managed care organization (MCO) that employs him rather than to his individual patient. And don't take too much comfort in the government regulation of MCOs, for example, the banning of gag rules, drive-through obstetrical deliveries, and 48-hour mastectomies. They bring in more government, more laws, and more regulations to fix problems created by government intervention in the first place. Remember the words of James Madison: "Crisis is the rallying cry of tyrannical governments."

Recently, Dr. Harvey F. Wachsman, a neurosurgeon and lawyer wrote in The Wall Street Journal: "First HMOs restricted doctors' ability to practice as they saw fit, limiting their ability to order tests, admit patients to the hospital and refer patients to specialists. Apparently these companies, whose executives are reaping lofty salaries in the face of huge profits, are not content with merely controlling the way physicians practice medicine. They are now trying to take patient care out of their hands completely and turn it over to nurses, who lack the training and expertise doctors possess. As a neurosurgeon and attorney, I have already seen numerous cases of people whose lives have been destroyed because of ill-advised HMO policies..."(2)

Much has been said about banning gag rules and allowing doctors to talk to their patients freely (patient protection legislation), nevertheless, the fact remains as long as the doctor is beholden to the managed care network that employs him, and the perverted, flexible ethics of managed care reign supreme --- which, allows economic credentialing with deselection of physicians; gatekeepers with rationing of care; prepayment of medical care, including capitation, which promotes assembly-line medicine; and physicians to even sign "hold harmless clauses," etc. --- the doctor is beholden to the third-party payer (his employer) or the government rather than to his individual patient.

More specifically, regarding managed care and HMO capitation, a recent letter by Dr. Peter F. Holmes, a San Antonio physician, published in AMNews encapsulates the fact that prohibition of gag clauses is not going to work in allowing physicians to provide full informed consent and medical information to their HMO patients: "Capitation is in itself a gag clause. Through capitation, physicians are paid up front. The more they refer, the more x-rays they use, the more specialists they use, the less profit is made. Basically, the physicians are the insurance company. By the physicians taking capitation, they are bypassing any gag clause. Patients are totally unaware of their physician's financial incentive not to treat. President Clinton stating he is going to outlaw gag clauses, but at the same time to allow capitation, is political denial of the truth."(3)

Moreover, regardless of what managed care contracts contain or HMO officials proclaim, the truth, as enunciated by Julie Cantor-Weinberg, associate director of the employee benefit policy of the National Association of Manufacturers, is that "The doctor still has the duty to do what is in the best interest of the patient. Doctors take the Hippocratic Oath, and if they're not comfortable with the way the plan is set up, they shouldn't be joining it."(4)

Ethics and Organized Medicine

And this brings us back to the subject of ethics and organized medicine. What happened to the 1949 AMA policy proscribing the corporate practice of medicine? In 1949, the AMA's position on medical ethics and the corporate practice of medicine was succinctly summarized: "The physician should not dispose of his professional attainments or services to any hospital, by body, group or individual...under terms or conditions which permit exploitation of the services of the physician for the financial profit of the agency concerned." Part of the answer is found in recent pronouncements made by the AMA leadership. For instance, recently Physician's Weekly reported Dr. P. John Seward, executive vice president of the AMA as commenting: "Some physicians would rather the AMA commit its resources to the destruction of managed care...unfortunately, that's just not realistic." Yet, the AMA, according to the same report, is prepared to dip into its $130 million reserves to get its new managed care project rolling.5 The first contract is with United Healthcare, a managed care, megacorporation in which its CEO, William McGuire, earned $6.07 million in total compensation in 1994.(6)

Today, the AMA in its many publications and concisely reported in Internal Medicine News, "not only can tell you how to succeed in managed care, but can get you the money you'll need to be successful" when you establish your networks. The AMA sponsored Physicians Capital Source launched in February 1995 was designed to "help physicians develop a business plan, evaluate the plan, and link them with financing sources. AMA members get an initial consultation for free, and nonmembers are charged $1,000 up-front. Everyone pays regular rate for subsequent consultations." Furthermore, according to AMA public relations sources, "the start-up costs of physician-sponsored managed care entities range from a low of $10,000 for a service bureau all the way up to $15 million for a staff model HMO." It was also reported by AMA Trustee Dr. Donald T. Lewers that the project was to be funded through the fees and commissions the AMA receives "when a loan closes."7 Thus, here again with the corporate practice of medicine, it appears the application of flexible ethics allow policies to change to fit the times and make profits at the expense of patient care and the deterioration of the quality of medical care.

The popular radio commentator Paul Harvey (08/13/97) was right on target when he announced that the AMA "has become commercialized now endorsing products for a piece of the pie," referring to the multimillion dollar endorsement fiasco with Sunbeam Corporation.

The Oaths of Medical Ethics

Now, let us reflect on the meaning of the various oaths of medical ethics. Despite all of his accomplishments, Hippocrates is best known for his code of medical ethics, the timeless Oath of Hippocrates, which, even today, remains the bedrock of medical ethics --- 2500 years after its proclamation by Hippocrates and his followers in the School of Cos during the 4th and 5th Centuries B.C. Here is the celebrated Oath:

I swear by Apollo, the physician, and Æsculapius and Hygeia and Panacea and all the gods and goddesses that, according to my ability and judgment, I will keep this oath and stipulation: To reckon him who taught me this art equally dear to me as my parents, to share my substance with him and relieve his necessities if required: to regard his offspring as on the same footing with my own brothers, and to teach them this art if they should wish to learn it, without fee or stipulation, and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the art to my own sons and to those of my teachers, and to disciples bound by a stipulation and oath, according to the law of medicine, but to none others.

I will follow that method of treatment which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel; furthermore, I will not give to a woman an instrument to produce abortion.

With purity and holiness I will pass my life and practice my art. I will not cut a person who is suffering with a stone, but will leave this to be done by practitioners of this work. Into whatever houses I enter I will go into them for the benefit of the sick and will abstain from every voluntary act of mischief and corruption: and further from the seduction of females and males, bond or free.

Whatever, in connection with my professional practice, or not in connection with it, I may see or hear in the lives of men which ought not to be spoken abroad I will not divulge, as reckoning that all such should be kept secret.

While I continue to keep this oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men at all times, but should I trespass and violate this oath, may the reverse be my lot.

The first part of the Oath reminds the physicians that they are not gods, that they are subservient to a power greater than their own and that they should invoke whatever they hold sacred in the service of their profession. It then provides for the student-teacher, self-perpetuating apprenticeship system of learning, medical education and training, that characterized medicine as a learned profession.

Hippocratic physicians, as required by the Oath, generally repudiated abortion (except when the life of the mother was in danger, for the life of the mother was apprised above that of the unborn baby), but generally they deemed abortion unacceptable medical practice. Needless to say, active euthanasia was strictly proscribed by Hippocratic teachings; otherwise the physician was only bound by his oath to consider what was to the benefit of his patient. Most importantly of all: physicians' obligations were restricted to their individual patients, not to society at large.

Contrary to common belief, the Oath of Hippocrates does not proscribe surgery. The Oath reflects the attitude of those Asklepiads who became followers of Hippocrates and believed in the need for specialization --- an attitude that Hippocratic physicians should not perform surgery which they were not trained to do and which required the skills of a specialized surgeon. The same situation held true and applied to cases of nephrolithiasis (urinary stones) which required surgical treatment. Here again, the rationale was that since those cases required special expertise and since the doctor had the duty to advise what was best for his patient, he would turn over or refer those cases of urinary stones to surgical specialists who possessed the necessary ability and skills for the treatment of that specific malady.

So, as early as 2500 years ago, Hippocratic physicians recognized that as medical science progressed, it would be difficult, if not impossible, to master all the accumulated knowledge, and therefore, it was unrealistic and unfeasible for a physician to be versed in all branches of the profession. Therefore, both explicitly and implicitly in their writings were the concepts of specialization, consultations, and appropriate referrals for the benefit of the patient, first; and for the advancement of the art, and science of medicine, second.

The Oath of Hippocrates comprises the first set of precepts to formulate systematically a voluntary, self-imposed code of ethics --- an edification of professional morality --- unsurpassed in history.

The Oath also provides for ethical conduct in treating the ill and vulnerable, as well as protects patient confidentiality --- noble concepts heretofore unknown in any other profession, except the clergy. The Hippocratic tradition recognized the importance of honor and the need for a physician to remain above reproach.

There are other honorable oaths of medical ethics. The Oath of Maimonides embodies a concept of medical ethics, which like the Oath of Hippocrates, respects individual autonomy and does not subordinate the individual physician to the state, only to the service that he renders to his individual patients.

Moses Maimonides (1135-1204) was the most influential Jewish physician-philosopher of his age. Besides his code of ethics, his accomplishments included the philosophic synthesis between Aristotelian rationalism and Jewish theology in Judaism, in a similar fashion as St. Thomas Aquinas and St. Augustine accomplished in Christian theology --- reconciling reason and natural philosophy with religious dogma.

Here is the Oath of Maimonides: Exalted God, before I begin the holy work of healing the creations of your hand, I place my entreaty before the throne of your glory, that you grant strength of spirit and fortitude to faithfully execute my work. Let not desire for wealth or benefit blind me from seeing truth. Deem me worthy of seeing in the sufferer who seeks my advice a person neither rich nor poor. Friend or foe, good man or bad; of a man in distress, show me only the man.

If doctors wiser than me seek to help me understand, grant me the desire to learn from them, for the knowledge of healing is boundless. But when fools deride me, give me fortitude! Let my love for my profession strengthen my resolve to withstand the decision even of men of high station. Illuminate the way for me, for any lapse in my knowledge can bring illness and death upon your creations. I beseech you, merciful and gracious God, strengthen me in body and soul, and instill within me a perfect spirit.(8)

Unfortunately, some of the more recent oaths of medical ethics are not so faithful to the tradition of Hippocratic ethics and, as we shall see, have a tendency to subordinate individual autonomy to the collective will of the state.

Some of the ways the ethics of the profession are being perverted and transmogrified is through the trivialization and deliberate misinterpretation of the core principles of medical ethics as exemplified in the replacement of the Oath of Hippocrates with more up-to-date oaths that allow the applications of more flexible ethics that are supposedly more attuned to the zeitgeist of our times.

Robert Lowes writing in The New Physician, the official journal of the American Medical Student Association, states: "Although reciting a pledge at graduation has become more widespread in recent years, the Hippocratic Oath isn't necessarily hip among new docs anymore."(9) And, Dr. Robert M. Veatch, director and professor of medical ethics at the Kennedy Institute of Ethics at Georgetown University in Washington, D.C. affirms: "Another major flaw in the [Hippocratic] Oath is a narrow individualism that fails to balance the needs of society. [Emphasis added.] As such, the Oath offers no guidance to today's health-care reformers."(9) To which I reply with enthusiasm that today's health care reformers are not the dedicated physicians in the trenches but government bureaucrats and their counterparts in the health care megacorporations and armchair academicians who are seeking to change the ethics of Hippocratic medicine to that of the corporate morality of managed competition.

Other more recent oaths have, therefore, been recited to assuage or circumvent "troublesome" passages in the Hippocratic Oath, like, for example, where the latter states, "I will prescribe regimen for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug, nor give advice which may cause his death."

The Oath of Lasagna, written in 1964 by clinical pharmacologist Dr. Louis Lasagna, dean of the Sackler School of Graduate Biomedical Sciences at Tufts University in Boston, reads in part: "If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God." And, "I will remember that I remain a member of society...." [Emphasis added.](9)

In 1989, the American Medical Student Association's (AMSA) Task Force on Bioethics wrote an oath that was eventually adopted by AMSA because, as one student put it: "Surprisingly, none of the revised Hippocratic or currently available modern oaths reflect the...physician social responsibility and personal and collective indebtedness to others." [Emphasis added.] Another passage states: "I will strive to transform the social and environmental factors that adversely affect our health."(9)

Likewise, in 1994, Harvard Medical School administered an oath that, according to one of the three oath-writers, "As far as content went, we believed we could make it more concordant with our political views..." [Emphasis added.] Additionally, the Harvard oath states: "I recognize that I have responsibilities to my community: to promote its welfare and speak out against injustice." The oath-writer commented that, "this addition arose from an activist mind-set in the student body. Many of us had been involved in politically-oriented groups to address problems such as domestic violence."(9)

Never mind that the oath of the Declaration of Geneva (adopted in 1948 and amended in 1983) in the wake of World War II and revelations of Nazi doctor atrocities proclaims: "I will not permit considerations of religion, nationality, race, party politics, or social standing to intervene between my duty and my patient..."(10) [Emphasis added.] Fresh in the minds of those doctors writing the Oath of the Declaration of Geneva, but lost in the collective memory of the new oath-writers, was Nazi Germany's Führer Adolf Hitler's concept of the health of the nation to which German physicians flocked in droves, joining the Nazi party and cooperating and collaborating in cleansing the health of the nation by attaining Aryan racial purity, for the collective good of German society.

The recent revisions in the AMA's code of medical ethics try to walk a tightrope balancing individual autonomy and the needs of society. The Preamble to the AMA Principles of Medical Ethics states: "As a member of this profession, a physician must recognize responsibility not only to patient but also to society...." Furthermore, Principle 7 states: "A physician shall recognize a responsibility to participate in activities contributing to an improved community."(11) You might ask, "So, what's wrong with that?"

The problem with compromising ethics and subordinating the individually-based patient-doctor relationship based on trust between the patient and his/her physician to the purported needs of society, the community, and/or the collective good is that it opens the door to the perversion of medical ethics, and the subjugation of the individual to the collective and the profession to the state.

For instance, the Soviet Oath of medical ethics approved in 1971, with one addition on nuclear war in 1983, declares: Upon having conferred on me the high calling of physician and entering medical practice, I do solemnly swear:

To dedicate all my knowledge and strength to the preservation and improvement of the health of mankind and to the treatment and prevention of disease, and to work in good conscience wherever it is required by society; To be always ready to provide medical care, to relate to the patient attentively and carefully, and to preserve medical confidences; To constantly perfect my medical knowledge and clinical skills and thereby in my work to aid in the development of medical science and practice; To refer, if the patient's better interests warrant it, for advice from my fellow physicians, and never myself to refuse to give such advice or help; To preserve and develop the noble traditions of Soviet medicine, to be guided in all my actions by the principles of Communist morality, and to always bear in mind the high calling of a Soviet physician and my responsibility to the people and to the Soviet state. Recognizing the danger which nuclear weaponry presents for mankind, to struggle tirelessly for peace, and for the prevention of nuclear war. I swear to be loyal to this oath as long as I live.(12)

Much of the language in the Soviet Oath, at cursory glance, seems to reflect benevolent ideas inherent to the medical profession. Nevertheless, close scrutiny reveals that it commands the individual physician to subordinate his or her autonomy to the will of central planners for whatever social engineering projects the state masquerades as deeds for "the good of society." The surrender of the individual's autonomy to the supremacy of the State is what totalitarian governments and increasingly, collectivist-welfare states mean by "society." This locution is contrary to the instinctive individualism of Americans, the Western concept of limited government, and the ideals of true charity, benevolence, and compassion of our Judeo-Christian tradition.

What this thinly-veiled, government-imposed, political document, posing as a professional oath, accomplishes is the subordination of the individual physician and his patients to society and the collective good, and the subjugation of the profession to the state and its surrogates. Tragically, the subordination of science and medicine to the state, history teaches us, inevitably leads to the corruption of both, to tyranny and democide.

Yes, the new oaths today in Western social democracies are drifting in that authoritarian direction to pave the way for establishing general conformity with the state and prevailing societal values to be engendered in the up-and-coming young physicians. Even the reference to nuclear war in the Soviet Oath is noteworthy. Today, we know that the peace movement, notably in Europe, was subsidized by the Soviet Union to soften European resolve and accomplish unilateral disarmament on the part of the United States and its allies.

Forms of the aforementioned oath and the phrase, "for the benefit of society," have been used by totalitarian and collectivist-welfare states to oppress and incarcerate individuals and members of political, religious, or ethnic minorities throughout this turbulent century. And it is not only former totalitarian states like the Soviet Union and Nazi Germany that have committed democide, genocide, or eugenics. We already know about active euthanasia in the Netherlands where the majority of family physicians participate and thousands of patients, many without their consent, and others consenting, but with psychiatric illnesses such as depression, undergo euthanasia in violation of the Oath of Hippocrates.

Recent reports have tainted the U.S. government with violations of the civil rights of citizens both with radiation research and the Tuskegee Institute (syphilis) experiments. And now, more recent revelations also taint the Scandinavian socialist utopias, Norway, Denmark, and the heretofore darling of the soft-left political movement, Sweden. It turns out documents reveal that from 1935-1976, "The Swedish governments sterilized 60,000 women to rid Swedish society of 'inferior' racial types and to encourage Aryan features." The journalist who brought this information to light concludes, "The most astonishing thing is the ideological difference. In Germany it was the Nazis and in Scandinavia it was the welfare states that showed the most willingness to cleanse themselves of 'racially' or 'socially inferior' types."(13)

In these socialist regimes, whether of the hard- or soft-left variety, "society" is a veritable synonym for the powerful state itself when it wants to make itself inconspicuous and trounce the civil liberties of unwary citizens. Our legacy of God-given rights or natural rights we treasure, such as life, liberty, property, and the pursuit of happiness, are eroded away and become nonexistent. These rights may be obliterated by a myriad of excessive laws or government edicts proclaimed by the regulatory state (as is happening today in our own U.S.) or if granted at all, are qualified out of existence by the state, as was the case in the constitutions of all the former communist states, is still the case in the Western social democracies and, most notably, is underscored in the United Nations Covenant on Civil and Political Rights.(14)

Control of the Profession --- Its End Result

We have seen how authoritarian states may nullify (and have nullified) ethics of Hippocrates and imposed their own brand of collectivist ethics upon physicians and assigned them social responsibilities for the state's political benefit. The physician's individual effort and ability may go unrecognized, unless, of course, recognition is of benefit to the state. Thus, the physician becomes merely an instrument of political control, another useful tool for the appeasement or distraction of the masses (or special interest groups) with such amenities as free or discounted services. He or she is manipulated like a chess pawn and used at the discretion of the state for social engineering, or any other unspecified social or political purpose that is considered "for the good of society."

In fact, the Swiss philosopher, Professor Ernest Truffer, contends that a new veterinary ethic that rejects the traditional medical ethic requiring a physician to care for his/her patient according to the patient’s specific medical requirements, is substituting the traditional ethics of Hippocrates. This new veterinary ethic consists of caring for the patient as if he/she were a sick animal, not in accordance with its specific medical need, but according to the wishes of its master or owner—the person or entity responsible for paying the medical bills, including the state.(18)

The implications for today --- with the persistent intrusion of government into medicine and the growth of managed care organizations --- are staggering, the ramifications as overwhelming as they are frightening. Regardless of body polity and ideology, what should be clear is that control of the medical profession by the unholy partnership of government and its counterparts in the private sector (i.e., the managed care network megacorporations working under monopolistic government protection), will be ominous, not just for physicians but even more so for the uninformed public.

How, you might ask, does the present situation in America compare to that of Nazi Germany? How could civilized physicians be transformed into dark angels of death for the national socialist Nazis? Joseph M. Scherzer, M.D., former president of the Arizona Chapter of the AAPS, has answered both of these questions precisely: In the highly civilized society of Germany, physicians participated in "direct medical killing and systematic genocide" because of lebensunwertes leben ("a life unworthy of life") --- an "ethical" concept carried out voluntarily by German physicians under the auspices of the state for the good of German society. Over 200,000 German citizens died in this fashion before the Holocaust. Dr. Scherzer writes, "Physicians were no longer caretakers of an individual patient, but rather promoters of the general health of the German people. Physicians were servants of the state rather than independent [Hippocratic] practitioners."(15)

And, psychiatrist Anna Scherzer, M.D., notes: "[In America today] the patient is no longer the central individual around whom and for whom the art of healing was developed. Our function is no longer primarily to care for a person. We are managing covered lives, ostensibly for some greater national or budgetary good. Is this so different from what was demanded of physician's in Hitler's Germany?"(16)

This dark descent into barbarism, a product of doctors cooperating with the state, at the expense of their individual patients, should not be allowed to happen: The lessons of history sagaciously reveal wherever the government has sought to control medical care, medical practice and physicians (whether directly or indirectly), the results have been as perverse as they have been disastrous. In our own century, in the Soviet Union, in Nazi Germany, and in fascist Italy, medicine regressed and descended to unprecedented barbarism under the aegis of, or in partnership with, the state.(17)

One sure way to avoid the formation of this unholy alliance is to keep medicine independent and separate from government and its surrogate managed care networks. With the growth of democratic socialism at home, it is imperative that medical practice frees itself from the government's and their surrogates, the managed care megacorporations', stranglehold to prevent the impending suffocation of Medicine's independence.

(In Part II of this essay which will appear in the March/April issue of the Medical Sentinel, I will further expound on the subject (and ethical conflicts) of managed care practice, ethics of Hippocrates, and the response to these changes by organized medicine.)

Dr. Faria is a consultant neurosurgeon and author of Vandals at the Gates of Medicine (1995) and Medical Warrior: Fighting Corporate Socialized Medicine (Macon, Georgia, Hacienda Publishing, Inc, 1997). He is also Editor-in-Chief of the Medical Sentinel.

More than once I have been asked something to the effect: "How does a physician reconcile his/her successful practice, the business of medicine, frequently becoming a lucrative proposition for doctors and the Oath of Hippocrates? Why do physicians go into Medicine?

First, the Oath of Hippocrates does not say that physicians need to become monks to practice medicine. In fact altruistic Benedictine monks did practice medicine during the Dark Ages, doubling as barbers and medical practitioners in a desperate age, as I have related in Vandals at the Gates of Medicine, but that came nearly a thousand years later! The Oath (which is also discussed and posted in articles in this website) insists in a code of medical ethics that I have also discussed in the same book, but it does not say that physicians join the ranks of self-deprecating monks to do so.

Physicians do answer a professional calling and by far most of them do follow Hippocrates code of ethics. Moreover, I believe doctors can be idealistic and "humanitarian" (i.e., a better word than "altruistic," a term which I do not particularly like), and even be individualistic to some extent, while following the requirements of good medical practice, medical ethics and the Oath of Hippocrates. Physicians do have a right to also enjoy the fruits of their humanitarian and professional labors.

Consider the words of the great Graeco-Roman physician Galen (A.D. 130-200):

"The physician should be contemptuous of money, interested in his work, self-controlled, and just. Once he is possessed of these basic virtues, he will have all others at his command as well." And hear the affirmation of the English Renaissance physician and early medical ethicist, Sir Thomas Browne (1605-1682)in his meditations on medical ethics, his opus Religio medici (1642):

"But how shall we expect charity towards others, when we are uncharitable to ourselves? 'Charity begins at home,' is the voice of the world; yet is every man his greatest enemy, and, as it were, his own executioner."

According to Hippocrates, Galen and Browne, a physician has an obligation to place his patients' interest first when practicing medicine, but at the same time a conscientious physician has also a right to enjoy the benefits of long years of study, his arduous unending work, the fruits of his labors, even while exercising the serious responsibilities that go along with being a caring and dedicated physician. The process is called enlightened self-interest because a successful, humane, and competent physician benefits from his labors, but even greater benefits accrue to his/her patients and society at large. — MAF